Ultrasound Blocks for the Anterior Abdominal Wall

More documents

Recommendations

Info

90 | Ultrasound Blocks for the Anterior Abdominal Wall higher absorption of local anesthetic has been shown (Smith 1996). The cause may be the increased cardiac output/body mass index ratio, the decreased tissue accumulation and the reduced liver metabolism. When large doses of local anesthetic are used, the dose per kilogram should be reduced by about 15% (Rosenberg 2004). Children under two years of age have been reported to have significantly higher pain scores than those above this age (Trotter 1995). Ropivacaine as a long-lasting agent for IIB in children may be more effective when used with a high concentration/small volume than when used with a high volume/low concentration (Trifa 2009). If smaller volumes of local anesthetic are used, ultrasounds become a necessary tool in order to improve the chance for a successful block. Adjuvants Several studies have evaluated the use of adjuvants to local anesthetics (clonidine, ketamine ecc) for improving postoperative analgesia after the anterior abdominal blocks. Clonidine added to intermediate or long-acting local anesthetics for single-shot peripheral nerve or plexus blocks prolongs the duration of analgesia and motor block by about 2 h but at the cost of an increased risk of hypotension, fainting, and sedation and with an unclear dose-responsiveness kinetics (Pöpping 2009). Clonidine used for the abdominal blocks or IFB/LIA has not shown to give a clinically important benefit in adults and children (Beaussier 2005, Kaabachi 2005, Dagher 2006, Elliott 1997). A common adverse effect is orthostatic hypotension during the first postoperative hours. In these types of block, as a consequence of the spread into a wide zone, the accumulation of clonidine near nerves may be decreased. Thus clonidine would not reach the right level to affect nerve conduction or facilitate the action of the local anesthetic (Kaabachi 2005).
13. Complications | 91 13. Complications Zhirajr Mokini Transient Femoral Nerve Block The most frequently described complication after an IIB is the transient postoperative block of the femoral nerve (Rosario 1994, Rosario 1997). It may occur both after selective IIB or TAPB or after an IFB/LIA performed by the surgeon. The transient femoral nerve block (TFNB) may be partial or complete, sensory and/or motor (Wulf 1999). The transient femoral nerve block includes a reduced sensation of the skin overlying the anterior and lower medial portion of the thigh and weakness of the thigh expressed as a difficulty in standing up and walking (Erez 2002). Special attention is required, since there may be a 2.5 to 6 hour delay between the injection of the anesthetic and the onset of TFNB (Kluger 1998). Once the TFNB is present, it may persist for up to 36 hours (Salib 2007). Complete spontaneous recovery before 12 hours has been generally reported (Erez 2002, Rosario 1997). The TFNB is a potential cause of delay in patient discharge and a cause of possible complications like minor injuries or even fractures from subsequent falls (Szell 1994). The awareness of
Page 1 and 2:
the Flying Publisher Guide to Ultra
Page 3 and 4:
Zhirajr Mokini Giovanni Vitale Amed
Page 5 and 6:
| 5 Preface Somatic post-surgical p
Page 7 and 8:
| 7 Savino Spadaro Department of Ex
Page 9 and 10:
| 9 Table of Contents 1. Anatomy fo
Page 11 and 12:
| 11 Pediatric Considerations......
Page 13 and 14:
1. Anatomy for Anesthesiologists |
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
2. Ultrasound and Regional Anesthes
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
3. Transverse Abdominal Plexus Bloc
Page 37 and 38:
3. Transverse Abdominal Plexus Bloc
Page 39 and 40: 3. Transverse Abdominal Plexus Bloc
Page 45 and 46: 4. Iliohypogastric and Ilioinguinal
Page 53 and 54: 5. Genitofemoral Nerve Block Zhiraj
Page 55 and 56: 5. Genitofemoral Nerve Block | 55 s
Page 57 and 58: 5. Genitofemoral Nerve Block | 57 p
Page 59 and 60: 5. Genitofemoral Nerve Block | 59 e
Page 61 and 62: 6. Rectus Sheath Block | 61 Figure
Page 63 and 64: 6. Rectus Sheath Block | 63 Table 6
Page 65 and 66: 7. Inguinal Hernia Repair Roberto F
Page 67 and 68: 7. Inguinal Hernia Repair | 67 comp
Page 69 and 70: 7. Inguinal Hernia Repair | 69 Ilio
Page 71 and 72: 8. Inguinal Surgery in Children Giu
Page 73 and 74: 8. Inguinal Surgery in Children | 7
Page 75 and 76: 9. Obstetric and Gynecologic Surger
Page 77 and 78: 9. Obstetric and Gynecologic Surger
Page 79 and 80: 10. Other Abdominal Surgery Procedu
Page 81 and 82: 10. Other Abdominal Surgery Procedu
Page 83 and 84: 11. Abdominal Midline Surgery Savin
Page 85 and 86: 12. Local Anesthetics, Pharmacokine
Page 87 and 88: 12. Local Anesthetics, Pharmacokine
Page 89: 12. Local Anesthetics, Pharmacokine
Page 93 and 94: 13. Complications | 93 Peritoneal a
Page 95 and 96: 13. Complications | 95 Figure 13.2
Page 97 and 98: 14. References | 97 14. References
Page 99 and 100: 14. References | 99 Caetano AM, Fal
Page 101 and 102: 14. References | 101 Fredrickson M,
Page 103 and 104: 14. References | 103 Kark AE, Kurze
Page 105 and 106: 14. References | 105 (3) McDonnell
Page 107 and 108: 14. References | 107 Rankin G, Stok
Page 109 and 110: 14. References | 109 Toivonen J, Pe
Page 111 and 112: 15. Index | 111 15. Index Index abs
Page 113: goo.gl/cKezE the Flying Publisher G
show all

Ultrasound Blocks for the Anterior Abdominal Wall

Create successful ePaper yourself

Delete template?

Save as template?